Presumptive Long Rod Technique (PLRT) for Revision Extension Instrumented Spine Surgery: A Technical Note

Volume 3 | Issue 2 | October 2022-March 2023 | page: 119-124 | Ajay Krishnan, Shivakumar A Bali, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan, Vatsal Parmar, Pranav Charde, Vikrant Chauhan, Mirant B Dave, Denish Patel, Preety A Krishnan, Bharat R Dave

DOI: https://doi.org/10.13107/bbj.2022.v03i02.050


Authors: Ajay Krishnan [1], Shivakumar A Bali [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan [1], Vatsal Parmar [1], Pranav Charde [1], Vikrant Chauhan [1], Mirant B Dave [1], Denish Patel [1], Preety A Krishnan [2], Bharat R Dave [1]

[1] Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
[2] Department of Radiology, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Ajay Krishnan,
Spine Surgeon, Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
E-mail: drajaykrishnan@gmail.com


Abstract


Background: Revision spine surgery needing extension of fixation either require complete exposure of previously operated levels for rod exchange or can be managed by linking the new surgical construct (NSC) to primary surgical construct (PSC) with dominos. Presumptive long rod technique (PLRT) provides additional length of rod for domino placement.
Case report: 80-year male on conservative management developed acute cauda equina syndrome retention due to pre-existing multilevel lumbar stenosis and acute big sequestrated disc prolapse at L12. Emergent surgical intervention in form of L1 to L4 pedicle screw fixation with postero-lateral bone grafting and fragmentectomy was done. Peri-operative period was uneventful. He was started on Teriperatide 20mcg daily with progressive mobilization and physiotherapy. At 4 months of follow-up, he developed L1 osteoporotic fracture with proximal junctional kyphosis (PJK). Patient underwent T12-L1 interbody fusion with extension of fixation to T10 which required complete opening up of previous incision as it was an Indian implant set. A domino of larger foot print couldn’t be accommodated in the space available between L1- L2 screws. Owing to severe osteoporosis and degenerative changes at proximal levels, presumptive oversized rods were inserted with extra lengths of the rods left at proximal ends. This technique is labelled PLRT(presumptive long rod technique) at our institute. At 6 months of follow up, patient developed T10 osteoporotic fracture with PJK and patient was planned for extension of fixation upto T4. Since the extra lengths of rods were available at proximal ends, only the planned operative levels were exposed and it was connected to previous construct using the larger footprint domino. Patient improved clinically and was ambulatory. The patient expired at 18 months due to cardio-respiratory arrest unrelated to the spinal events.
Conclusion: Additional rod lengths intentionally left at adjacent levels during primary surgery where there is anticipation of PJK and adjacent segment disease (ASD) can be a boon when there is need for extension of fixation. These extra lengths of rod can be used to place dominos and connect PSC to NSC without the need for exposure of PSC levels for rod exchange, preventing complications especially in setups with economic constraints.
Keywords: Complex, Adult Spinal Deformity, Adjacent Segment, Junctional Kyphosis, Osteoporosis, Revision, Surgery, Multirod.


References


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How to Cite this Article: Krishnan A, Bali SA, Degulmadi D, Mayi S, Ranjan R, Parmar V, Charde P, Chauhan V, Dave MB, Patel D, Krishnan PA, Dave BR | Presumptive Long Rod Technique (PLRT) for Revision Extension Instrumented Surgery: A Technical Note | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 119-124. https://doi.org/10.13107/bbj.2022.v03i02.050

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Hirayama Disease: A Rare Case Report and Literature Review

Volume 3 | Issue 2 | October 2022-March 2023 | page: 109-112 | Sharvin K Sheth, Amit C Jhala, Jay V Shah

DOI: https://doi.org/10.13107/bbj.2022.v03i02.048


Authors: Sharvin K Sheth [1], Amit C Jhala [1], Jay V Shah [2]

[1] Department of Spine Surgery, Chirayu Orthopaedic and Spine Hospital, Ahmedabad, Gujarat, India.
[2] Department of Radiology, Medimax Advance Radio Imaging, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Amit C Jhala,
Consultant Spine Surgeon and Chief of Department of Spine Surgery, Chirayu Orthopaedic and Spine Hospital, Ahmedabad, Gujarat, India.
E-mail: acjhala@gmail.com


Abstract


Hirayama disease is a rare neurological condition and is characterized by a sporadic juvenile muscular atrophy of distal upper extremity in young males. The disease is more prevalent in Japan and other Asian countries, though a few cases have been reported in Western countries as well. It manifests as a self-limiting, gradually progressive atrophic weakness of forearm and hand. The anterior displacement of posterior dura during neck flexion leading to cervical cord atrophy has been hypothesized. We discuss a case of a 21-year-old male patient with progressive distal upper extremity weakness, diagnosed with Hirayama disease, and literature review for the same.
Keywords: Hirayama Disease, Juvenile muscular atrophy, Monomelic amyotrophy


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How to Cite this Article: Sheth SK, Jhala AC , Shah JV |  Hirayama Disease: A Rare Case Report and Literature Review | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 109-112. https://doi.org/10.13107/bbj.2022.v03i02.048

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New Development and Progression of Ossification of the Posterior Longitudinal Ligament (OPLL) after Cervical Disc Arthroplasty: A Case Report

Volume 3 | Issue 2 | October 2022-March 2023 | page: 47-50 | Jong-Beom Park

DOI: https://doi.org/10.13107/bbj.2022.v03i02.040


Authors: Jong-Beom Park [1]

[1] Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address of Correspondence

Dr. Jong-Beom Park,
Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
E-mail: spinepjb@gmail.com


Abstract


Purpose: To report an extremely rare case of new development and progression of ossification of posterior longitudinal ligament (OPLL) after cervical disc arthroplasty (CDA).
Background: To our knowledge, new development and progression of ossification of OPLL after CDA have not been reported.
Methods: A 44-year-old female with cervical disc herniation at C5-6 presented with radiculopathy. The patient had no evidence of preexisting OPLL on plain radiographs and magnetic resonance imaging. She underwent CDR at C5-6 and her symptoms were significantly improved after surgery.
Results: New development of OPLL at C5-7-T1 was identified for the first time at 6 years after CDA at C5-6, and progression of OPLL was observed at 3 & 13 years’ follow-up. Due to new development and progression of OPLL, there was no segmental motion at C5-6 with CDA. The patient continued to follow up without further surgery because there was no deterioration in clinical symptoms.
Conclusion: Our study demonstrated an extremely rare case of new development and progression of OPLL after CDA with a long term follow-up. Our case suggests potential clues for discovering the complex pathological mechanism of OPLL.
Keywords: Ossification of the posterior longitudinal ligament, New development, Progression, Cervical disc arthroplasty


References


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21. Katsumi K, Izumi T, Ito T, et al. Posterior instrumented fusion suppresses the progression of ossification of the posterior longitudinal ligament: a comparison of laminoplasty with and without instrumented fusion by three-dimensional analysis. Eur Spine J 2016;25:1634-1640.
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How to Cite this Article: Park JB | New Development and Progression of Ossification of the Posterior Longitudinal Ligament (OPLL) after Cervical Disc Arthroplasty | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 47-50. https://doi.org/10.13107/bbj.2022.v03i02.040

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Post-Discectomy Pyogenic Lumbar Discitis- A Literature Review

Volume 3 | Issue 2 | October 2022-March 2023 | page: 55-64 | Udit D. Patel1, Hitesh N. Modi1

DOI: https://doi.org/10.13107/bbj.2022.v03i02.042


Authors: Udit D. Patel [1], Hitesh N. Modi [1]

[1] Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India 380054.

Address of Correspondence

Dr. Udit D. Patel
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: uditpatel27@gmail.com


Abstract


Introduction: Post-disctectomy pyogenic lumbar discitis is not common condition in contrast to postoperative wound infection but its presentation is typically non-specific, which can lead to delay in diagnosis and its treatment. In this condition, patients present with low back pain after symptoms free interval. The diagnosis can be established with symptoms, examination, laboratory studies and radiological investigations.
Purpose: The aim of this literature review is to evaluate available articles about post- discectomy lumbar spondylodiscitis. we analyse the incidence, risk factors, causative organisms, diagnosis modalities (including clinical features, blood and radiological investigations), management strategies (conservative and surgical) and prevention for postoperative lumbar spondylodiscitis in the published literature.
Material and methods: We have reviewed literature articles available on topic of post-discectomy lumbar discitis in PubMed, MEDLINE and Google scholar only in English language; and have been published from the year 2000 onwards.
Results: This incidence rate of post-operative discitis is 0.94%. The age range was 38-56 years with a mean age of 45.18±4.17 years. Mean interval between discectomy and establishment of diagnosis was 2-8 weeks. Of all the patients included 61.93% were males and 38.07% were females. The most common organism isolated is staph. aureus (including methicillin sensitive and resistant staph. aureus). Majority of patients were initially treated conservatively. The surgical treatment in patients who fail to respond to conservative management has been demonstrated. Our study showed 40.1% excellent results, 56% good result and 3.9% fair and poor result at final follow up.
Conclusion: Although the incidence of post-operative lumbar discitis is rare, it’s associated with morbidity and mortality. The true challenge of post-operative discitis is to diagnose the condition timely. Majority of patients can be treated conservatively and operative management is rarely necessary in the patients with failed conservative treatment.
Keywords:  Lumbar discectomy, Postoperative pyogenic discitis, Literature review, Treatment


References


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How to Cite this Article: Patel UD, Modi HN | Post-Discectomy Pyogenic Lumbar Discitis- A Literature Review | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 55-64. https://doi.org/10.13107/bbj.2022.v03i02.042

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Clinical, Functional and Radiological Outcome of Posterior Lumbar Interbody fusion by Banana cage with Bone graft for the treatment of High-grade Lumbar Spondylolisthesis at L5-S1.

Volume 3 | Issue 2 | October 2022-March 2023 | page: 90-95 | Md. Anowarul Islam, Md. Mohoshin Sarker, Suvradev Saha, Afia Ibnat Islam

DOI: https://doi.org/10.13107/bbj.2022.v03i02.046


Authors: Md. Anowarul Islam [1], Md. Mohoshin Sarker [1], Suvradev Saha [1], Afia Ibnat Islam [2]

[1] Department of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
[2] Department of Spine Surgery, Holy Family & Red Crecent Medical College & Hospital, Dhaka, Bangladesh.

Address of Correspondence

Dr. Md. Anowarul Islam,
Professor of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
E-mail: maislam.spine@gmail.com


Abstract


Objectives: To assess the clinical, functional and radiological outcome of posterior lumbar interbody fusion (PLIF) by Banana cage with bone graft.
Material and Methods: This retrospective analytical study was carried out in spine unit of Orthopaedic surgery department of BSMMU, and other private hospital in Dhaka from January 2010 to December 2020. We did PLIF by Banana cage with bone graft for High-grade Lumbar Spondylolisthesis at L5-S1. The follow-up period ranges from 1- 2 years (average 18 months. All patients were assessed by VAS, ODI, WDI, Spino-pelvic parameters, Modified Macnab’s Criteria to find out overall outcome and Hackenberge ctriteria for radiological fusion.
Results: Total 40 patients were included among 16 were male and 24 were female. The average age of the patients was 52.45±10.1 years. 60.0% patients were housewife ,20.0%, 10.0%, 10% were day laborer, farmer and service holder respectively. Average pelvic tilt was 26.05±6.27° preoperatively and 24.10±6.26° at the final follow-up, average PI was 66.07±7.39° preoperatively and 61.19±7.08° at the final follow-up. Preoperative lumbar lordosis was 45.55± 6.71° & at final follow-up 37.29±6.19°. VAS score and ODI scales were improved significantly from preoperative 6.90 ± 6.16 and 57.60±15.66 to at final follow-up 2.0±0.8 and 7.60±2.40. Pre-operative Translation ratio, slip angle and disc height ratio were 21.96±10.25, -18.87±8.28, 11.03±4.36 and at postoperatively 13.17±6.57, -18.44±7.12, 19.60±3.36. Fusion was achieved in 36 cases (90%), 3 cases (7.5%) were fragmented and pseudoarthrosis showed only 1 case (2.5%). Post-operative clinical outcome showed excellent outcome (95%), 1 (2.5%) case had good and 1 (2.5%) case had fair outcome.
Conclusion: It can be concluded that, PLIF by Banana cage with bone graft is a very good option for the treatment of High-grade Lumbar Spondylolisthesis at L5-S1 levels.
Keywords: Posterior Lumbar Interbody Fusion, High-grade Spondylolisthesis, Visual Analogue Score, Oswestry Disability Index, Waddell disability index, Hackenberge criteria, Pelvic parameters.


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How to Cite this Article: Islam MA, Sarker MM, Saha S, Islam AI | Clinical, Functional and Radiological Outcome of Posterior Lumbar Interbody fusion by Banana cage with Bone graft for the treatment of Highgrade Lumbar Spondylolisthesis at L5-S1| Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 90-95. https://doi.org/10.13107/bbj.2022.v03i02.046

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Outcome of ACCF in Multilevel Cervical Spondylotic Myelopathy with OPLL and Kyphotic Deformity

Volume 3 | Issue 2 | October 2022-March 2023 | page: 78-83 | Md. Anowarul Islam, Suvradev Saha, Md. Mohoshin Sarker, Afia Ibnat Islam

DOI: https://doi.org/10.13107/bbj.2022.v03i02.044


Authors: Md. Anowarul Islam [1], , Suvradev Saha [1], Md. Mohoshin Sarker [1], Afia Ibnat Islam [2]

[1] Department of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
[2] Department of Spine Surgery, Holy Family & Red Crecent Medical College & Hospital, Dhaka, Bangladesh.

Address of Correspondence
Dr. Md. Anowarul Islam,
Professor & Unit Head of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
E-mail: maislam.spine@gmail.com


Abstract


Purpose: To evaluate the Outcome of Anterior cervical corpectomy & Fusion in multilevel Cervical Spondylotic Myelopathy with Ossification Posterior Longitudinal Ligament & kyphotic deformity.
Background: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the adult. Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition of the spine, where the PLL becomes progressively calcified, leading to spinal canal stenosis. Anterior decompression by corpectomy and removal of ossified posterior longitudinal ligament is a well-recognized technique for decompressing the cervical spine. The involved vertebral body/bodies are removed and after assuring adequate decompression, titanium mesh cage filled with autogenous bone graft is placed in the gap with reinforcement by anterior cervical locking plate and screw.
Materials & Method: Retrospectively we reviewed 15 cases from 2010 to 2021 of CSM with OPLL and kyphotic deformity. All the patients with positive MRI & CT scan findings and underwent ACCF by mesh cage with bone graft. Neurological improvement was assessed by the Nurick Score , improvement of pain control by VAS score, fusion rate by Bridwell’s criteria & Overall functional assessment by modified Odom’s score .
Results: Total number of patients was 15. Average age was 60 years (range 35-85). Average follow-up period was 18 months. Post-operatively, Nurick scores improved by grade 1 in 7 patients, grade 2 in 5 patients, grade 3 in 2 patients, and grade 4 in 1 patient. In our series we have no chair bound or bedridden patients after surgery. There was no difference in myelopathy outcomes comparing patients older and younger than 75 years . There was no radiographic progression after surgery. But, more than 90% patients had kyphotic correction of 10-20ͦ respectively.
Conclusion: ACCF is a safe and effective method in treating the CSM with correction of few degrees of kyphotic deformity.
Keywords: ACCF, Mesh cage, Locking plate


References


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How to Cite this Article: Islam MA, Saha S, Sarker MM, Islam AI | Outcome of ACCF in Multilevel Cervical Spondylotic Myelopathy with OPLL and Kyphotic Deformity| Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 78-83.  https://doi.org/10.13107/bbj.2022.v03i02.044

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Fusion with stabilization for the treatment of post-operative Lumbar spondylodiscitis: Our experience

Volume 3 | Issue 2 | October 2022-March 2023 | page: 84-89 | Md. Anowarul Islam, Wayez Mahbub, Suvradev Saha, Afia Ibnat Islam

DOI: https://doi.org/10.13107/bbj.2022.v03i02.045


Authors: Md. Anowarul Islam [1], Wayez Mahbub [1], Suvradev Saha [1], Afia Ibnat Islam [2]

[1] Department of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
[2] Department of Spine Surgery, Holy Family & Red Crecent Medical College & Hospital, Dhaka, Bangladesh.

Address of Correspondence
Dr. Md. Anowarul Islam ,
Professor of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
E-mail: maislam.spine@gmail.com


Abstract


Objective: To analyse the outcome of fusion with stabilization for the treatment of postoperative lumbar spondylodiscitis.
Background: Post-operative spondylodiscitis is a dreadful complication following disc surgery. Treatment option is either conservative or operative, but till date, there are no universally accepted treatment protocol. Many studies suggest early surgical intervention provides good outcome. Different mode of surgical interventions can be applied for its treatment like debridement only, debridement followed by fusion with or without stabilization. In this study, we treat all of our patients having post-operative spondylodiscitis by fusion with stabilization.
Materials & methods: Retrospectively we reviewed 20 cases from January 2016 to July 2021 in Bangabandhu Sheikh Mujib Medical University and other private hospitals of Dhaka, Bangladesh. Post-operative spondylodiscitis was diagnosed according to history, specific clinical findings, laboratory and radiographic investigations. Surgery was the treatment of choice in our cases. Pre and postoperative evaluations were done by the Visual Analog scale (VAS), Nurick score for neurological outcome, Modified Kirkaldy–Willis criteria for functional outcome and Modified Lee’s criteria for fusion assessment.
Results: Total number of patients was 20. Mean age was 48 years (range 22-83). Average follow-up period was 12 months. The period between the surgery and the onset of symptoms was 14 to 28 days. Pre-operative VAS score was 8.10±1.7 and post-operatively was 1.7±0.6 at the last follow-up (P< 0.001). Pre & post-operative Nurick score was 2.7 & 0.7. Functional outcome was assessed in our study by Modified Kirkaldy-Willis criteria which shows 90% patient have satisfactory outcome while 10% have unsatisfactory outcome. Modified Lee’s criteria show definitive fusion in 55%, probable fusion in 35% & possible pseudarthrosis in 10% cases.
Conclusion: Early diagnosis and proper management are the keys to successful outcome of postoperative spondylodiscitis. Surgical management in the form of fusion and transpedicular fixation can give excellent results.
Keywords: Sondylodiscitis, Fusion, Stabilizationp


References


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How to Cite this Article: Islam MA, Mahbub W, Saha S, Islam AI | Fusion with stabilization for the treatment of postoperative Lumbar spondylodiscitis: Our experience | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 84-89.  https://doi.org/10.13107/bbj.2022.v03i02.045

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.

A Case Report of Aspergillus Fungal Spinal Infection in Immunocompetent Patient and Review of Literature

Volume 3 | Issue 2 | October 2022-March 2023 | page: 113-118 | Udit D. Patel, Hitesh N. Modi

DOI: https://doi.org/10.13107/bbj.2022.v03i02.049


Authors: Udit D. Patel [1], Hitesh N. Modi [1]

[1] Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Thaltej, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Hitesh N. Modi,
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India.
E-mail: modispine@gmail.com


Abstract


Background: Spinal aspergillus infection is rare but can cause significant morbidity and mortality. Sometime it may mis-diagnosed as pyogenic or tuberculous infection in immunocompetent patients. Therefore, it causes delay in diagnosis and leads to spinal instability, neurological deficit, and sometimes death.
Case Report: Here we discussed a case of 68 years old female patient with severe back pain and difficulty in walking which was gradually increased over the period of time of two months. During this, she was diagnosed as koch’s spine based on MRI report and she had been started on empirical anti-tuberculous medication. But her condition was deteriorated. After that patient underwent surgical management and infected tissue sent for culture and sensitivity and histopathological examination. The report was positive for aspergillus fungal infection. she was started with anti-fungal medication and course of treatment was uneventful.
Conclusion: Early diagnosis of spinal fungal infection is often delayed in immunocompetent patients and it lead to delayed in anti-fungal management which lead to increase in morbidity and mortality.
Keywords: Aspergillus, Spinal fungal infection, Case Report


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How to Cite this Article: Patel UD, Modi HN |  A Case Report of Aspergillus Fungal Spinal Infection in Immunocompetent Patient and Review of Literature | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 113-118. https://doi.org/10.13107/bbj.2022.v03i02.049

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Patient and Parent’s Knowledge, Emotion and Expectation Evaluation in Conservatively Treated Adolescent Idiopathic Scoliosis: A Prospective Randomized Study in 200 Children by a Simple Questionnaire

Volume 3 | Issue 2 | October 2022-March 2023 | page: 96-108 | Hitesh N. Modi, Seung-Woo Suh, Jae-Young Hong, Jae-Hyuk Yang

DOI: https://doi.org/10.13107/bbj.2022.v03i02.047


Authors: Hitesh N. Modi [1, 2], Seung-Woo Suh [1], Jae-Young Hong [1], Jae-Hyuk Yang [1]

 

[1] Scoliosis Research Institute, Department of Orthopaedics, Korea University Guro Hospital, Seoul, South Korea.
[2] Department of Orthopaedics, Zydus Hospital and Healthcare Research Pvt Ltd, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr Seung-Woo Suh,
Scoliosis Research Institute, Department of Orthopaedics, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul, South Korea.
E-mail: spine@korea.ac.kr


Abstract


Objectives: To find out if any disparity of the knowledge regarding the scoliosis, treatment, psychological status and treatment satisfaction between different groups of children based on age, follow-up or treatment modality (bracing or observation) and, between patients and their parents.
Summary of Background Data. There are numerous questionnaires available in scoliosis which specifically measures either operative outcome or bracing outcomes in terms of general appearance, psychological appearance or pain scores. There is no questionnaire available that evaluate the overall general knowledge, their psychological status regarding the treatment, knowledge regarding future such as progression of curve, marriage, pregnancy and health status as well as their expectations and choices from the treatment in conservatively treated AIS patients.
Methods: Study was conducted in 200 children with adolescent idiopathic scoliosis (AIS) with age between 10 and 16 years. All 30 questions were divided into four subgroups to evaluate 1) General knowledge (Q 1-9); 2) Emotional and psychological status (Q 10-16); 3) Treatment knowledge (Q 17-25); and 4) Treatment satisfaction (Q 26-30). Results were evaluated based on treatment modality (bracing or observation); duration of follow-up (less than or more than 12 months), and age (less than or more than 13 years), and also between patients and parents.
Results: General knowledge remains the same (p>0.05) in all subgroups, while treatment knowledge was higher in parents (p<0.0001) and in patients with follow-up more than 12 months (p=0.0009) while age of patients didn’t show any difference (p=0.083). Psychological disturbances were found more in parents (p=0.046), and patients with longer follow-up (p=0.001) and higher age (p=0.002). Similarly, parents (p<0.0001), and patients with follow-up more than 12 months (0.011) and age more than 13 years (p=0.009) had higher treatment dissatisfaction. However, the treatment modality (bracing or observation) didn’t exhibit any difference (p>0.05) in any questionnaire.
Conclusion: We evaluated general and treatment knowledge, psychological and mental status and treatment satisfaction from a single and simple questionnaire in conservatively treated AIS subjects, which would provide useful information to handle the different issues involved with the disease.
Keywords: Adolescent idiopathic scoliosis, Conservative treatment, Questionnaire, Evaluation.


References


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How to Cite this Article: Modi HN, Suh SW, Hong JY, Yang JH | Patient and Parent’s Knowledge, Emotion and Expectation Evaluation in Conservatively Treated Adolescent Idiopathic Scoliosis: A Prospective Randomized Study in 200 Children by a Simple Questionnaire | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 96-108. https://doi.org/10.13107/bbj.2022.v03i02.047

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Gorham Stout Disease- A Rare Disorder with Ambiguous Recommendations: A Systematic Review of literature.

Volume 3 | Issue 2 | October 2022-March 2023 | page: 65-77 | Ajay Krishnan, Preethesh Agrawal, Vatsal Parmar, Vikrant Chauhan, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan, Shiv Kumar Bali, Prartham C Amin, Pranav R Charde, Preety A Krishnan, Mirant R Dave, Bharat R Dave

DOI: https://doi.org/10.13107/bbj.2022.v03i02.043


Authors: Ajay Krishnan [1], Preethesh Agrawal [1], Vatsal Parmar [1], Vikrant Chauhan [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan [1], Shiv Kumar Bali [1], Prartham C Amin [1], Pranav R Charde [1], Preety A Krishnan [2], Mirant R Dave [1], Bharat R Dave [1]

[1] Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
[2] Department of Radiology, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Ajay Krishnan,
Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
E-mail: drajaykrishnan@gmail.com


Abstract


Background: Vanishing bone disease / Gorham-Stout disease (GSD) is a condition that produces deformity and instability of bone. The fibro lympho-vascular tissue replaces the bone leading to massive osteolysis and its sequelae, but the exact cause is yet unknown. The disease involves the spine infrequently, but due to the proximity of the spinal cord it can seriously affect the patient. The aim of this study is to report as a review to contribute to the diagnosis, and treatment modalities in GSD affection of spine with the reported literature available from 1983 till March 2022.
Materials & Method: This metanalysis study is focused on GSD involving the spine. The search was done in two databases PubMed and Google scholar from 1983 up to March 2022. The Study selection was done to study the demographic pattern of GSD in spine and its outcome with conservative and surgical treatment and to determine the best suitable medical treatment for stopping disease progression and achieving remission.
Results: We retrieved 72 articles from Google scholar and PubMed out of which 5 articles were excluded (90 reported cases). Heffez criteria was followed for diagnosis in all these cases (n=86, 95.5%). 57 patients (64%) were operated and 33 patients (36%) were managed conservatively. Per-operative failure to achieve a fixation/reconstruction were reported in 2 (2.53%) cases. Number of surgeries till follow-up were average 1.70+ 1.23 (1-5) surgeries. The average follow-up of cases reported was 47.1+ 48.9 (3-240 months). Union was documented in 10 cases (3.4%). 9 of these cases needed additional bone graft/substitute. Bisphosphonates(n=40), sirolimus (n=5), interferon (n=17), radiotherapy (n= 31) and beta-blockers (n=4) were given in medications. 23 patients had remission. Death occurred in 17 patients (18.88%).
Conclusion: Surgery is needed frequently. Failure of fixations, achieving union and remission are daunting and ’off  label” therapies are the dictum. Radiotherapy has been used more frequently with or without bisphosphonates. Though promising medical treatment are evolving and focus of treatment is directed towards anti-angiogenic, anti-osteolytic and anabolic therapy, but no standard treatment recommendations can be made out from existing literature.
Keywords: Vanishing bone disease, Gorham stout, Osteolysis, Spine, Deformity, Sirolimus, TNF


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How to Cite this Article: Krishnan A, Agrawal P, Parmar V, Chauhan V, Degulmadi D, Mayi S, Ranjan R, Bali SK, Amin PC, Charde PR, Krishnan PA, Dave MR, Dave BR | Gorham Stout Disease- A Rare Disorder with Ambiguous Recommendations: A Systematic Review of literature | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 65-77.  https://doi.org/10.13107/bbj.2022.v03i02.043

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